Published DateCONCORD — The Finance Committee of the New Hampshire House of Representatives has arguably shunted some $7-million in costs for caring for the elderly to the 10 counties in the next biennium in balancing its version of the 2014-2015 state budget, which will come before the House for a vote next week.
In 2008, the Legislature assigned the non-federal share of the cost of youth services to the state while placing the non-federal share of the cost of long-term care on the counties. Counties reimburse the state for expenses for caring for the needy elderly and chronically ill placed in licensed nursing homes — other than the county nursing home — and receiving home or community based care. Acknowledging that the rise in costs of long-term care would outpace those of youth services, the total billings to the counties were capped and the counties were granted another $7.5-million in credits against the caps.
The caps and credits are allocated among the counties according to their shares of expenditures incurred in the prior year and proportion of residents 65 or older enrolled in Medicaid. The higher the amount of the cap, the greater the cost to the counties and the less the cost to the state. The Legislature set the caps at $105-million for 2011 and 2012, $107-million for 2013 and originally was slated to be $109-million for 2014.
Last week, the Finance Committee raised the caps to $109,900,000 in 2014 and to $115,050,000 in 2015. Representative David Huot (D-Laconia), who serves on the committee, said yesterday that the decision was based on a through analysis of projected caseloads and estimated costs and suggested that experience may well indicate that the contribution of the counties was appropriate. Likewise, Representative Mary Jane Wallner (D-Concord), who chairs the Finance Committee, writing in the House calendar, claims that "the bill lowers the cap on costs counties pay for long term care," apparently assuming that expenditures will exceed the higher cap and the share of costs born by the counties will be proportionate as the Legislature intended.
On the other hand, Representative Neal Kurk (R-Weare), a longtime member and past chairman of the Finance Committee, writing for the minority of the committee describes the measure as "a true downshift of at least $7-million to the county property taxpayers."
Estimating the fiscal impact on the individual counties, the New Hampshire Association of Counties projects that raising the cap will add between $600,000 and $700,000 to the Belknap County budget during the biennium, with most of the increase falling in fiscal year 2015. The county currently budgets approximately $5.5-million for long-term care.
Soon after the exchange of responsibilities was originally enacted the New Hampshire Association Counties filed suit, alleging that transferring responsibility for long-term care to the counties represented an unfunded mandate in violation of Part I, Article 28-a of the state Constitution. The court upheld the statute, finding that since prior to the enactment of the statute the counties had paid half the non-federal share of long-term care costs and since then had not incurred additional expenditures.